Best Docs Talk

What’s changed since you graduated medical school, and what do you see on the horizon?

I began practice in the pre-Internet era. If I had a question about a rare medical condition, I would spend a weekend in a medical library going through lists of journals. Currently, the same investigation can take place in such a brief time that I can often give patients an answer to questions while they are in the office.-Steven Janousek, Neurology

I suspect at some point we will be able to detect/diagnose tumors by testing blood or spinal fluid, which will lead to potential earlier diagnosis of tumors without the need for invasive procedures.-Anne Bendel, Pediatric Oncology

When I first entered genetics, the genome project was just getting off the ground. Now we are looking toward a future where it will be commonplace for individuals to know in advance about conditions that may happen due to genetics. It is my hope and expectation that we will be able to identify a greater number of conditions early in life and, with early treatment, prevent or lessen the severity of serious illness.-Lisa Schimmenti, Genetics

The game-changer for the 21st century is sequencing the human genome.-David Ahrenholz, Burn Treatment

Allergists are seeing more severe allergic conditions than in years past. The future will bring more complicated allergic patients who need stronger immune-blocking drugs.-Mee Lee Nelson, Allergy & Immunology

For the more than $2 trillion we have allocated to our health-care system, we need to aim for and achieve the best in the world. -Woubeshet Ayenew, Cardiology

What has changed since I graduated from medical school is the increased incorporation of technology—from imaging, molecular biologic testing for diseases, and technology such as ultrasound for invasive procedures to the development of robotic surgery for different types of intricate surgical procedures and the development of bionic limbs for amputees.-Andrew Kiragu, Critical Care Medicine–Pediatric

I am most surprised what has not changed. Heart disease was the No. 1 killer of Americans when I graduated, and it still is. The most promising changes are the ability to prevent and diagnose it so much earlier than we have been able in the past.-Retu Saxena, Cardiology

It used to be that when your child was diagnosed with a rare disease, you may have never heard of it before and certainly had never met another family affected with it. Now, families can connect in these online communities and really feel they’re not alone.-Michelle Rheault, Nephrology

We can treat children’s cancers, breathing problems, and birth defects much better than we could when I went to medical school. We even treat common problems like ear infections differently: fewer antibiotics, a much less aggressive approach. The future is very bright.-James Sidman, Pediatric Otolaryngology

What would you like your patients to know about your job that you feel they don’t?

This is the greatest job on earth. -Jonathan Braman, Orthopedics

Most patients are pretty savvy. I believe they understand that doctors are not perfect but are human and are doing their best to treat their patients.-Joan Van Camp, Breast Surgery

I want patients to understand the many burdensome regulations, constraints, and obstacles that stand between doctors and their patients. When an administrative barrier arises, it can be as disheartening to the doc as to the patient.-Charles Reznikoff, Addiction Medicine

I love my job and wouldn’t do anything differently, but I worry about my patients like they are my own kids. It’s not uncommon for me to wake up in the middle of the night and ruminate for a while about a difficult diagnosis or complication that one of them is having. You are not forgotten when you walk out of the office!-Michelle Rheault, Nephrology

It’s not uncommon for a physician to have seven hours of face-to-face time with patients but work 11-hour days or longer. The extra time comes in preparing to see patients, reviewing their charts, getting back to patients about results, communicating with other providers, interacting with insurance companies, entering chart notes, responding to phone calls, and so on. The vast majority of physicians are not taking the afternoon off to play golf!-Peter Kent, Rheumatology

Not every clinical problem requires tests to diagnose or medications to treat. Sometimes, less is more. The challenge is to know when to be more aggressive and when to be more conservative.-Scott Glickstein, Rheumatology

Emergency medicine is the only specialty that has dedicated itself to treating any condition, at any time, any place without any socioeconomic restrictions, and it has a long track record to prove it. -David Plummer, Emergency Medicine

Oncology is as much science as it is art. As a physician, I find myself as tightly bound to the PhD making the next discovery in his lab as I do to the nurse holding the hands of my patients and their parents.-Christopher Moertel, Hematology

Dermatologists are experts not only in diseases primarily affecting the skin, but also in internal disorders that manifest clues there. Skin health is an important and complicated aspect of a person’s overall health. -Clark C. Otley, Dermatology

Very few careers offer such an intimate view into the lives of others, with the opportunity to make that life better or comfort [their] suffering. Most of us would not trade it for any other calling.-Robert Matlock, Gastroenterology

I would want them know we worry about them, care about them, and think about them. When we beat cancer together, we feel joy for them, and when things don’t go the way we want, we grieve with them.-Daniel Price, Otolaryngology

Allergists are like detectives. The clues (signs and symptoms) may be at the crime scene (where a reaction occurred) or may be pieced together with outside evidence (searching the internet for ingredients in the culprit food, considering what allergen cross-contaminated the food, questioning whether animal dander on someone’s furniture came into contact with you, etc.).-Nancy Ott, Allergy & Immunology

What should a patient keep in mind while visiting a physician to achieve the best outcome?

I recommend writing down your questions and bringing them along. It can be a little overwhelming during a doctor’s visit, and it’s important that your concerns are addressed. -Katherine Murray, Developmental Behavioral Psychology

I think most patients now come very well-prepared to their appointments, but getting a cancer diagnosis is always scary and can be paralyzing. I always encourage patients to ask questions and consider getting a second opinion. We often do more research on buying a car than we do on having surgery.-Daniel Price, Otolaryngology

The physician-patient relationship is a partnership. Medicine has gotten so complex that patients should be participating fully in their health care by staying informed and communicating with their providers. My best patients are those who are well-informed about their conditions and ask questions.-Lisa Schimmenti, Genetics

It’s important to understand time constraints and to know that physicians are often excellent at tackling one or two problems in a visit but more than that may best be handled by separate visits.-Peter Kent, Rheumatology

Although past medical records and notes (available to review in the electronic medical record) are important for a number of reasons, there is nothing that can replace the patient’s perspective about what is going wrong for them in their body or a parent’s perspective about their child at the time of the doctor visit. -Nancy Ott, Allergy & Immunology

If it is a more serious appointment, such as discussing cancer treatment, always bring a companion. The doctor needs to communicate a lot in a small amount of time, and it is hard for most people to retain everything that was said, even if it was repeated more than once.-Rachel Hub, Dermatology

There’s a very true aphorism that says, “If you listen to the patient long enough, they’ll tell you what the diagnosis is.” Unfortunately today, more than ever, time constraints make effective communication difficult.-Christopher Viozzi, Oral & Maxillofacial Surgery

Ask your doctor to explain all the risks and benefits of opioids. If s/he can’t tell you the driving laws, storage tips, disposal laws, drug and alcohol interactions, and side effects, it should raise concern. Ask your doctor, “What if I get addicted to these pills?” If the doctor can’t tell you how s/he manages addiction in patients on controlled substances, or worse, tells you that you couldn’t possibly get addicted, see a different doctor.-Charles Reznikoff, Addiction Medicine

I believe seeking out a board-certified physician in the particular specialty area you need care in is of greatest importance. You can then be assured they have undergone structured training in their field, passed rigorous examinations by their governing bodies, and are committed to maintaining a high level of competency in their chosen field.-Jeffrey Morken, Colon & Rectal Surgery

Patients need to be honest with their physicians regarding their lifestyle and habits. -Clare Sercombe, Emergency Medicine

Treat us with kindness and respect, and we will do the same. If we are running late, we should apologize. When that happens, it is never because we were wasting time; rather, it is because someone else required that time, and we would do the same for you.-Robert Matlock, Gastroenterology

What information do you wish all of your patients knew or behavior do you wish they would adopt?

The best thing patients can do is to be lean and exercise every day. Walking and moving throughout the day is so lacking in many of our lives. Obesity and a sedentary lifestyle are terribly damaging. -Cheryl Bailey, Gynecologic Oncology

I think it is disappointing to my pediatric patients when I tell them that they could learn a lot from their grandparents. Often their grandparents have learned a lot and live a life with a healthy balance of work, volunteering, family, fun, regular exercise, regular sleep, and nutritious diets. My patients just think that’s boring!-Richard Vehe, Rheumatology

For older adults, walking can dramatically improve overall conditioning, and that impacts the ability to tolerate major surgery. The amount of cutting and subsequent recovery time from surgery is strongly related to body mass.-Arthur Ney, Organ Transplant

Less than 4 percent of the U.S. population walks to work, compared to 20 percent in Germany. Sedentary people have a 20 to 30 percent increased risk of heart attack and higher risk of diabetes. Also, about 10 percent of breast, colon, and other cancers are being linked to lack of exercise.-Bhavjot Kaur, Internal Medicine

It turns out eating some good fats are better for you than not eating them (in the form of tree nuts). Also, sugar may be more dangerous for our heart than certain fats. -Retu Saxena, Cardiology

It is very important that women take the time to take care of themselves. Often women are the “centers of influence” in their families, in their work environment, and in their communities. They need to remain strong, happy, and healthy so their circle of influence remains healthy as well.-Donna Block, Obstetrics & Gynecology

Sleep, especially for teenagers, is not a luxury. It is a biological necessity. It is difficult to hear about teenage driving accidents, suicide, and poor academic performance when available sleep research provides a way to improve outcomes in all three areas.-John Garcia, Sleep Disorders

If I could keep all of our children in the sun just long enough to generate some Vitamin D but not so long they have sunburns and keep them away from tobacco products, life would be great.-Christopher Moertel, Hematology

I would advise patients to talk to their family members about their medical history. A lot of disease risk, including risk of some types of kidney disease, is inheritable, and you should make sure your doctor knows about any disease in your family so that they can accurately assess your risk and treat you early, if need be. -Michelle Rheault, Nephrology

We are learning more about the reparative properties of sleep in acute illness and the importance of hydration in support of the immune system, highlighting the importance of the advice to “rest and drink plenty of liquids.”-Patrick Carolan, Pediatrics

We want to “rule out” risk. I think that this robs us of the joy of our days. We all have short, fragile lives. Getting medical care is important, but embracing our fragility and reveling in each day is more important. Medicine can’t tell you that you are immortal.-John McClure, Pathology

Exercise, eat well, drive carefully, and enjoy life, but do it responsibly with great regard for others.-William Heegaard, Emergency Medicine

What has you the most excited about practicing medicine in 2015?

Genetic markers are identifying which patients’ cancers are likely to respond to chemotherapy and which cancers are less likely to recur and therefore may not benefit from more aggressive treatment.–Joan Van Camp, Breast Surgery

We can now cure many cases of hepatitis C. This is a major breakthrough, and the hope is that it will extend to other chronic viral illnesses, such as HIV.-Greg Lehman, Internal Medicine

We now know that there are many different types of breast cancer, and we can use targeted therapies to treat most types based on their molecular profile. -Tamera Lillemoe, Pathology

The most interesting findings (to me as a fellow human) are in the fields of genetics and microbiology, and the relationships between us and the microbial world. What is becoming clearer is that we are completely dependent upon our tiny partners, whose ongoing contribution to our daily lives is slowly being recognized as even more integrated than we appreciated just a few years ago. -Thomas Wright, Anesthesiology

There are two innovations that have great potential to improve urologic care in 2015. First is the progress in minimally invasive surgeries, such as robotic and image-guided procedures. Second is the continued growth in data on various diseases, such as kidney and prostate cancer, that has allowed us to better determine which patients need which procedures and which patients do not need any treatment at all. -James Anderson, Urology

The latest and still-evolving MRI techniques have led to significantly improved outcomes.-Glenn Buttermann, Orthopedics

The invention of anti-nausea meds for my patients getting chemo, making nausea a thing of the past. -Cheryl Bailey, Gynocological Oncology

Cardiology has changed significantly in the past few years. But as much as I love echocardiography, I am most excited about the new echo technology that is coming to everyday practice. This includes using very small bubbles to visualize the heart muscle’s very small vessels, as well as utilizing 3-D echocardiography to help guide new valvular-replacement techniques that no longer require open-heart surgery.-Retu Saxena, Cardiology

One of the most prevalent liver diseases in the US is hepatitis C (HCV), which affects about 6 million Americans. Although most people with HCV carry the virus without serious complications, a minority of people will get advanced liver disease or cancer after many years of infection. The most striking advance is the availability of new, highly effective treatments for HCV that should allow us to eradicate the virus.-Jeffrey Albrecht, Gastroenterology

The incidence of kidney failure is increasing, but research in the prevention and treatment of kidney disease is making promising advances to turn that trend around. Much of that research has origins in Minnesota. Kidney transplantation is very successful. Cell-based therapies are on the horizon as a novel way to treat kidney failure and engineer the growth of kidneys, thereby eliminating waiting lists for transplants.-Thomas Schwab, Nephrology

Bridging the gap between surgery and noninvasive procedures is the wave of the future. Patients are going to have many more options for self-improvement without undergoing the knife.-Jennifer Harrington, Plastic & Reconstructive Surgery

I am excited by the evolving understanding of HPV [human papiloma virus] and its role in cancers in women. We are better at screening and treating women who are at risk for cervical, vulvar, and rectal cancers and, importantly, not overtreating milder abnormalities that will resolve on their own.-Kathryn Flory, Obstetrics & Gynecology